Guest Articles Archives - Page 5 of 15 - Lawyers With Depression

Depression and Anxiety in Later Life

I’m Dan Lukasik from Lawyerswithdepression.com. Today’s guest is Dr. Charles F. Reynolds, III, co-author of the book, “Depression and Anxiety in Later Life: What Everyone Needs to Know.” He is a professor in Geriatric Psychiatry at the University at Pittsburgh School of Medicine and Director of its Aging Institute and Center of Excellence in the Prevention and Treatment of Late Life Mood Disorders. Dr. Reynolds is internationally renowned in the field of geriatric psychiatry. His primary interests focus on mood, grief, and sleep disorders in later life. Thanks for being here with us Dr. Reynolds.

I think the first place to begin for our audience and listeners is to have an understanding of what clinical depression is.

Dr. Reynolds:

The term clinical depression really refers to a syndrome or collection of symptoms which are debilitating and cause suffering and distress. At the core of the notion of clinical depression are two symptoms. The first is a lack of pleasure or interest in usual activities. The clinical term for that being anhedonia and the other core aspect of depression is a persistent lowering of mood – a sense of sadness and pessimism or even of hopelessness. These symptoms occur most days for at least two weeks and typically for a longer period of time and then as the full syndrome of depression develops, Dan, you also see other changes, for example, in sleep, concentration, or appetite, or energy levels and of great importance is the emergence, in many people, of suicidal feelings as part of the clinical syndrome of major depression.

Dan:

Part of the title of your book is anxiety – what is clinical anxiety?

Dr. Reynolds:

Well, like depression, clinical anxiety refers to a syndrome or collection of symptoms that are both distressing and impairing in day-to-day function. The principle types of anxiety are first, excessive worrying such as we see in generalized anxiety disorder or panic attacks such as we can see in panic disorder with or without agoraphobia. Like depression, anxiety disorders can be quite debilitating and distressing. It is also important to understand that anxiety and depression can co-occur in the same patient and often represent risk factors for each other.

Dan:

In the book title you say depression and anxiety in later life. When you talk about “later life,” what does that mean?

Dr. Reynolds:

Later life generally refers to folks sixty and older. That varies somewhat according to the study that you’re reading, but most of us accept age sixty or sixty-five as a threshold for beginning the later years of life. That being said, Dan, it’s important to understand that the later years of life can and often do cover several decades. And so we often speak of “young old,” say sixty-five to seventy to eighty, and “old-old” as covering the years beyond seventy-five or eighty. That distinction, young-old and old-old is important for clinical practice because the various benefits and risk of the treatments that we have may shift gradually with the age of the patient.

Dan:

When we think of depression in our society, how common is depression statistically and is there any difference in the older population?

Dr. Reynolds:

If you look, Dan, at primary care medicine clinics where most people get treatment for depression, older adults, if they get treatment at all, at any one point in time six to ten percent of the patients attending primary care clinics will have major syndromal depression and then another ten percent or so will have a clinically significant level of depressive symptoms. So this is by no means a rare disorder. The other important thing to remember, and this is to your point about depression’s occurrence in older adults, it frequently coexists with medical issues and often with cognitive issues as well. The depression typically doesn’t exist in pure culture, but rather is an “unwanted co-traveler” of many of the common medical problems that afflict older adults and thereby amplifies the disability and distress of those disorders.

Dan:

What causes depression, Dr. Reynolds? When we think of depression – and we’ve come a long way in understanding some of the causes – many people don’t know the difference between sadness or “the blues” and clinical depression. What are we talking about? What are the causes?

Dr. Reynolds:

The causes are many, Dan, and I think it’s very helpful to think in terms of there being many pathways to depression in older adults. In some cases, it’s possible that there is a genetic cause because depression can run in families. Although in late life, depression, we think that genetic factors are maybe less important than they are in younger adults or kids who develop depression. Depression also occurs in the context of the life events that can occur in later life such as bereavement or other major transitions in social role functions. It’s also not unusual to see depression in the wake of certain medical events like a heart attack, or a stroke, or depression to develop in the context of things like age-dependent macular degeneration which results in a decreased ability for a person to see. These are important contextual factors and a good treatment plan will take these contextual social and medical factors into account.

Dan:

When we think of depression, once it’s been diagnosed, what can older adults do to manage depression?

Dr. Reynolds:

I think there are many things that older adults can do, Dan, but also they can be helped by family members and caregivers as well. This is a key point. I almost always will try to see family members and caregivers as well as the adult with depression themselves. Adopting a healthy lifestyle is very important set of strategies, Dan, both for preventing and treating depression and among these healthy lifestyles are physical activity, maintaining good social connections, and social support, and getting primary medical problems attended to such as blood pressure, blood fat, and blood sugar levels and having your immunizations and cancer screenings done on time. Behaviorally, it’s very important for people to engage in the activities that give them pleasure. Behavioral activation, as we call it, is at the core of many psychosocial treatments for depression including problem-solving therapy, cognitive and behavioral therapy. Medications are also very helpful. There are antidepressant medications now available which are safe and generally well tolerated by older adults. I would say that upwards of eighty percent or eighty-plus percent of older adults with depression can be successfully treated to good response if not remission particularly using a combination of counseling and medication and then we have other treatments for other people whose depressions are difficult or resistant to treatment.

Dan:

Let’s turn our attention now to the topic of anxiety and that’s certainly an important topic you address in your book where you talk about anxiety in later life. For our audience, what is anxiety? We talk about it. A lot of people talk about being “stressed out”. We’re a stressed-out culture. But what is the difference between stress, being stressed-out, and true clinical anxiety?

Dr. Reynolds:

That’s good, Dan. You’ve made an important distinction there. All of us can experience stress, for example, in relation to life events which feel threatening to us or which seem to turn our worlds upside down, but there is a difference with anxiety disorders. Anxiety disorders are constituted by specific symptoms that often last for months and months and months and can be disabling and distressing. Principal among these things are obsessive worry or panic attacks which seem to come out of nowhere. These constituent actual distinct mental disorders and there are useful treatments for them. We rely heavily, for example, on teaching people relaxation techniques as well as better problem solving skills. There’s a good deal of literature also to support the use of medications called Selective Serotonin Reuptake Inhibitors. These are medications that have shown to be effective in the treatment of anxiety disorders in older adults. The reasons you want to treat these disorders is that the symptoms are burdensome, they cause distress and impairment, they undermine the quality of life, and also increase the risk for depression.

Dan:

When we talk about clinical depression and clinical anxiety, and you’ve just done a wonderful job of distinguishing them from everyday sadness and everyday stress, do they ever happen together? Can we have a person who has both clinical depression and anxiety?

Dr. Reynolds:

We see that, Dan, in really about a third of our patients. So at any one point in time, probably a third of our patients with major depression, also can be diagnosed with one or another anxiety disorders. So they do co-occur and they need to be treated. Sometimes it can be challenging to treat that combination, but we learned how to do that. The other thing to remember though is that people living with anxiety disorders are at risk for the subsequent onset of depression. So it’s important for that reason to address anxiety disorders. The other part of this constellation that I like to pay a lot of attention to is sleep disturbance. Sleep disturbances themselves represent a risk factor themselves for the onset of common mental disorders. Sleep disturbances are also a symptom of common mental disorders and when I’m treating depression or anxiety and my patient continues to have sleep disturbance, then I focus additional effort on helping them to get a better night’s sleep because if their sleep disturbance isn’t addressed independently, then it constitutes a risk factor for an early relapse or recurrence of depression or anxiety.

Dan:

Can you tell us a little more about your work at the Aging Institute at the University at Pittsburgh Medical College and the Center and Treatment of Late Life Mood Disorders?

Dr. Reynolds:

For the last five years I’ve served as Director of the Aging Institute at the University at Pittsburgh Medical Center. The Aging Institute was created by the UPMC Health System and its health plan and also by the six schools of the Health Sciences at the University at Pittsburgh and by the Provost at the University at Pittsburgh. Basically, Dan, we do three things. We geriatricize the work force. That is to say we teach the skills of caring for older adults to clinicians across all parts of medicine: doctors, nurses, pharmacists, social workers, etcetera. The second thing that the Aging Institute does is to develop new models of care to improve the long-term delivery of care to older adults and their family members. And finally, the third thing we do is to sponsor research. We are very interested in innovative pilot research that can lead subsequent National Institute of Health and other federal support. The other thing I do at Pitt is to direct the Center for Depression Prevention and Treatment Research. This is a Center of Excellence, one of only two or three in the United States funded by the National Institute of Mental Health. We have been working now since 1995 and are in our twenty-first year. We do a great deal of intervention research. We also train the next generation of younger scientists, both physicians and Ph.D.’s, to do intervention research in older adults at risk for living with mood disorders like major depression or bipolar disorder.

Dan:

One of the things you mention in your book, and by the way, it’s a remarkable, insightful read, “Depression and Anxiety in Later Life,” one of things you mention in your book, you talk about the importance for older people to find and maintain a sense of purpose. Why is that so important and how do older people go about finding a sense of purpose if it’s lacking?

Dr. Reynolds:

Yea, it’s a really key point, Dan, and I think that all of us need to have a sense of purpose; a sense that our lives matter to other people to help us get up in the morning. Feeling a sense of connection, feeling a sense of belonging is very strong medicine to preserving a sense of wellbeing throughout all of the years of life. There’s also a substantial body now of research, of epidemiological research, that shows that being a member of a community of faith may both help buffer depression and but also help to recover from depression and keep it at bay. So I think that’s one key strategy to create a sense of belonging and purpose. Those are two key words that I like to use – belonging and purpose.

Dan:

And in closing Dr. Reynolds, for those in our audience that are interested in this, interested in being evaluated and treated at your center, how do they go about doing that?

Dr. Reynolds:

You can give us a call in Pittsburgh. We are happy to take calls. We’re also happy to help callers find local resources from wherever they may be calling because we’re part of a network of colleagues around the country. One good way to seek help though is to call the help desk at the University at Pittsburgh Medical Center because we’re able to connect callers with all kinds of resources they may need. We typically get over 600 calls per year now, both from family caregivers and health care professionals. I recommend that people visit our website or call us at 866-430-8742.

Dan:

Dr. Reynolds, thank you so much for taking the time to talk with us today. It’s been very informative, insightful and encouraging. I’m Dan Lukasik with Lawyerswithdepression.com. Join us next week for another interesting interview.

Happy: An App That Replenishes Your Most Important Resources

On January 27, 2010, I became an uncle.

The day was surreal — not for me, but for my brother, who welcomed his first child into the world at 2:34 p.m.

Immediately after the baby was delivered she began experiencing respiratory distress, and at 2:35 p.m. the doctors and nurses whisked the newborn to the hospital’s neo-natal intensive care unit (NICU). At 2:37 p.m. — while standing in the NICU praying that his baby would hang on — the new father received a call on his cell phone from opposing counsel in a case halfway across the country, where a two-week trial was scheduled to begin in ten days.

This wasn’t just any old case — a seven-year old child with profound disabilities had been raped on a special needs school bus by a twenty-year old serial predator assigned to ride the same bus. The point of the trial was to determine what steps (if any) the school district was required to take to ensure that something like this wouldn’t happen again.

From 2:38 to 3:00, my brother negotiated a settlement in the NICU. To hear him tell it:

“With one hand, I was pressing the phone so hard to my ear that it left an indentation for a week. With my other hand, I was cupping the receiver as tightly as I physically could, so that the lawyer I was speaking with couldn’t hear the instructions the physicians were shouting to the attending nurses. If he had caught wind of the fact that I was standing in the NICU with my new baby, I would have lost any leverage to settle the case, and we almost certainly would have gone to trial. Thankfully, by the way, my wife has no memory of any of this.”

By 3:15 p.m., my niece began to breathe normally. Seven days later, my brother and his counterpart signed a settlement agreement that, among many other things, required the school district to place paid adult bus monitors on all special needs school buses.

I had not yet gone to law school when all this happened, and I recall being extraordinarily impressed with my brother. But now, I realize that almost every lawyer has at least one story like this. The simple fact is that lawyers experience tremendous stress from their vocation. Indeed, the practice of law is riddled with psychological land mines — tight deadlines, job insecurity, career dissatisfaction, pressure to achieve status (e.g, make partner), becoming emotionally invested in cases that may end unsuccessfully, feeling real fear of being chewed out for or embarrassed by a small error — to name just a few.

We experience such severe stress, and have such little discretionary time to address it, that it almost feels natural to reach for expedient but unhealthy solutions to life’s miseries (alcohol, prescription and non-prescription drugs, overly intensive exercise) that mask our problems instead of addressing them.

A group of Princeton graduates is building a valuable tool — called Happy — to help people like lawyers cope with stress and burnout in a healthier way that enables greater personal fulfillment and peace of mind. Their big idea is that a short conversation with a compassionate listener can quickly restore perspective and significantly boost a person’s happiness and health. Happy will soon be an on-demand app that connects callers to everyday people — lawyers, baristas, musicians, teachers, nurses, retirees, etc. — who have proven themselves to be exceptionally empathetic and highly effective. Happy is developing a community of these ‘happiness givers’ who are eager to hear your story, and help you in unexpected ways to find and experience the real happiness that is well within your grasp.

For now you can arrange a free conversation at one of the following links:

http://www.happytheapp.online/

https://calendly.com/hap/30min

By Jeremy Fischbach, Esq., B.A. Psychology, Princeton; J.D., NYU

An Interview with Will Meyerhofter About Depression in the Law

Will Meyerhofer, JD LCSW, is an author and a psychotherapist in private practice in NYC. He holds degrees from Harvard, NYU School of Law and The Hunter College School of Social Work. Following law school, he worked as an associate at the BigLaw firm of Sullivan & Cromwell in New York City before becoming a therapist. He is also the creator of the website and blog The Peoples’ Therapist. I spoke with Will about what depression is, how it forms and why so many lawyers are afflicted by it.

Dan: As someone who has suffered from depression and treats people for depression, what is depression and how does it develop?

Will: When Freud was asked why he went into neurology, and medicine, the career which developed, for him, into psychoanalysis, he said he was inspired by Charles Darwin’s astonishing breakthrough with the theory of evolution. Freud was an admirer of Darwin. That’s relevant, because evolution, I believe, plays an important role in depression. Depression is an evolutionary adaptation of humankind gone wrong.

It’s a bit like Sickle Cell Anemia, which is actually an adaptation in our blood intended to prevent Malaria. Unfortunately, that adaptation can also go too far and result in a harmful blood disorder.
Human beings have an enormously long childhood – the period of dependency following birth. That is chiefly due to our single most important adaptation – large brains, which at full size, would never fit through the birth canal. So we are born with a partially developed brain, about a third of its full size. As a result, our brains require a strikingly long period following birth– at least compared to most other higher species – to develop and mature. During that time, we’re utterly helpless. Many species are born, brush themselves off, and a couple of hours or days later, they are up and running around – just think of horses birthing foals. That’s not true for people. Humans take 10-14 years before they’re in any shape to take care of themselves. Our brains don’t even reach their full size until we’re about 6 years old.

Dan: What does this long period of childhood have to do with depression?

Will: We humans experience a very long period in our lives in which we demand and require enormous amounts of care in order to survive. Otherwise, we’d die. Little children comprehend that situation on a cellular level. If you walk away from a little child – make it clear that you are planning to abandon him for any length of time – that little child is going to absolutely flip; he is going to scream so loudly it will peel the paint off the walls. That’s because he knows he could die if he is abandoned. A child will always experience solitude as abandonment. To put it bluntly – the role of a human child is to please. It’s more intense for humans than for other life forms, because we require a lot more care and for a much longer period of time. Reptiles lay eggs and disappear. They might even feed on their own young and not think much of it. But mammals need care – milk from the mother. And of all the mammals, humans need the most care – years and years of it. So humans spend many years learning to please. We grow up with this directive to please – and blame ourselves if we fail at that task. It gets coded into our brains and becomes a trained behavior, an instinct. Keep in mind, the threat of death is real. Historically, as a species, humans display high rates of infanticide. This phenomenon exists in many species. Birds often cull their young and throw hatchlings out of the nest if there is insufficient food. But with humans, because we require so much care in our early years, if things are bad, it would not be uncommon to take a child who is disfavored – perhaps an illegitimate or disabled or otherwise undesirable child – and leave it out in the woods to die or simply abandon it as a street urchin. It is incumbent upon every human child to please so he can receive care and survive.

Ok, so how does this apply to depression? Under stress, humans regress – they fall back instinctively into old, unconscious behaviors acquired during childhood. In our case, that means falling back into the childhood pattern of locating the fault within – feeling that you’ve failed to please and that if you’re not pleasing, you are going to die. So, when you are under stress and things aren’t going well for you, you blame yourself – it must be your fault. Instead of acting like an adult, and getting angry and thinking – I’m not being treated well, I have a right to get angry and advocate for myself, or take care of myself, if no one else is going to do it – instead of that healthy, adult functioning, it’s the old regression, to “I’ve failed. It’s my fault. I’ll die because I’ve failed to please.”

An adult – unlike a child – does not have to experience solitude as abandonment. You can say I am an adult. I am independent. I can take care of myself. Not only that, I can choose an environment that’s healthy for me and I can reassure myself. I can self-sooth, I can self-parent. I can say to myself, hey you are a good person, come on. You choose who you are going to be each day. You are proud of who you are. You make that determination. You make that judgment whether you are worthy of being valued and receiving care each day. And you can tell yourself, Hey cheer up, you are going to get through this. You’re going to surround yourself with people who value you because that’s what you deserve and you are going to take care of yourself. And you can feel angry if you’re not receiving the care you deserve. That – in a nutshell – is how you address depression. You snap out of the regression to behaving like a dependent child and become an adult, a parent for your own child.

Dan: What signs do you look for to diagnose depression?

Will: There are two major indicators for depression that give it away each and every time.

First, I see an absence of appropriate anger. A child does not get angry when the parent fails to provide him with suitable care – the child sees himself as helpless. You can’t get angry at someone if you need them desperately, the way a child needs a parent. It’s not where the hell are you, I need a feeding, my diaper needs to be changed. Instead, the child’s in absolute panic and thinking I’m bad, I’m bad, I’ve failed here, I have failed to please – now they’ll leave me to die. That is the first characteristic of depression – absence of appropriate anger. If I ask a depressed client “Are you angry right now?” I’ll always hear the same answer. It will always be some variation of “I’m only angry at myself.” The rest of that statement would be “. . . because I’ve failed to please and can’t survive on my own.”

The Second indicator of depression is a dismantling of a person’s self-esteem apparatus. There’s no sense of pride in yourself or a sense of value in who you are and what you do. You think I failed, I hate being me. A depressed person will insist, over and over again – “I’m only angry at myself. I don’t like who I am.” That’s because the depressed person’s fantasy is to escape into someone else – someone who will please, and therefore be worthy of care – and survival.

Dan: The absence of appropriate anger and a dismantled self-esteem. I think those are two things that people on the street and even lawyers would associate with lawyers. We expect them to be tough and strong. We expect them to have high self-esteem and take pride in what they do. In your experience, why is the exact opposite true for lawyers struggling with depression?

Will: At a law firm, you are reduced to a child-like helplessness. You have no right to speak your mind, to self-advocate – to stand up to authority. Instead, you go helpless, and try to please. Any anger, if it is acknowledged to any degree, is tightly bottled. You can’t show it. The environment at law firms is uptight, rigid and extremely constrained. You can’t say to the partner – “Oh, for heaven sake, it’s Friday – why are you bothering me with this?” You say – “Yes, sir. I’ll do it right away.” If the partner – who is clearly exploiting you to make money – announces you are going to be working all weekend, you say “Absolutely, no problem.” You do not put up any kind of a fight. Lawyers, especially young lawyers, imagine themselves as helpless as young children in the law firm environment – utterly dependent on the partners, utterly incapable of advocating for themselves, or providing themselves with the care they need on their own. They permit themselves to be abused in an extremely toxic, exploitative environment – they often don’t even seem to realize they’re being abused. They’re too busy attempting to please their abusers.

Dan: Will, you treat a lot of lawyers with depression. Is depression in some way different for lawyers? Are there different causes for their depression?

Will: If I were to design an environment specifically to create depression, I would design a law firm. The reason is that lawyers are pleasers. A lawyer tends to be the kid with the best grades in the class – a generalist whose primary skill is getting good grades – pleasing teachers. If you are really good at math, you become a mathematician or a scientist. If you are particularly skilled on the violin, you become a musician. But if you get an “A” in everything, then your only skill set is getting good grades – and to monetize that skill set, you wind up heading to law school. That’s pretty much how I did it. I got into Harvard and then went on to NYU Law. I wasn’t spectacular at any one thing – I was a generalist. I was also the teacher’s pet. I was an excellent student – but what is an excellent student? It’s someone who gives the teachers what they want. Bill Gates, Mark Zuckerberg, they dropped out of Harvard, they weren’t good students – because they – and others like them – were geniuses, and entrepreneurs, not good students. Lots of geniuses drop out of college – it’s a common feature they share. They’re not pleasers. Einstein struggled to complete the academic rigamarole required to get a teaching post – he was too busy re-inventing physics.

Lawyers tend to be good students. A genius or an entrepreneur – an individualist – says I’m going to do it my own way and the hell with you. Screw Harvard. I don’t need it. This is in contrast to lawyer, the pleaser – the type of person who says I’m going to compete viciously with my peers and get straight A’s at Harvard and then go to a top law school and compete some more to get more straight A’s and then get a job at a top law firm and keep on competing. What happens to a pleaser when you get to these top firms? You do what you are told. And you compete. That’s a very typical lawyer behavior – you are essentially pleasing partners who are replacements for your parents and teachers, what therapists call the idealized parent object, the primary object – the person you’re programmed to please. And you are killing off your peers – the other children who compete for parental attention and care.

Dan: Big firms then have collections of pleasers and demanding partners. What does that do to the psyche of a lawyer?

Will: A law firm takes all these pleasers, herds all these kids who have always gotten A’s, and concentrates them in one giant feeding lot. So you have an entire law firm stocked with pleasers, and no one to please! There are no more teachers. The partners are the closest thing to a parent-object, and they’re overgrown pleasers themselves. It ends up with everyone competing with everyone else and everyone feeling like they’re failing. Throwing people under the bus is not a management technique except in a law firm. Anyone who’s ever worked in big law firms will tell you that folks get thrown under the bus every day at those places. It’s the antithesis of good management. That’s because they’re all competing – no one is stepping back and getting pleased, and saying – hey, you’re doing a terrific job! Good management is a requirement for happiness at a workplace. Everyone seems to realize that but lawyers. Employees need to feel supported, appreciated and motivated. They’ll do better work if they believe they’re good at what they do. Employees need to feel like they want to come in everyday because they like their workplace. Every time you walk in, you need to feel like Yeah, I know everybody here, my boss knows me, he respects me, he thanks me for my work. A good manager understands this – it isn’t rocket science. A fundamental management principle is that a review process needs to be supportive. There should be about 90% praise, and the constructive suggestions should be just that – constructive and suggestions. You don’t get anything remotely resembling that in a law firm because everyone is busy instinctively competing with each other like little baby animals trying to kill off the other baby animals as though they might die if someone else succeeds. Management technique, at a big law firm, amounts to throwing someone else under a bus, and thinking you feel better afterwards – like, somehow you’re now in a safer position. It’s madness.

Dan: Please tell us about your two books.

Will: My first book, Life is a Brief Opportunity for Joy, actually started out as notes for young therapists. I was doing training for volunteer counselors at a hospital and I kept repeating the same things over and over to them, explaining anxiety and depression. So I started with these notes and realized there was a book there that I could use with my clients. That’s one way to look at therapy – as educating your clients – training them, really, to be therapists themselves, to the extent that they gain an understanding of emotions and how they work.

The first part of the book is about gaining awareness and understanding how anxiety and depression work. The second part tackles applying that knowledge to your life as you live it.

It’s interesting, how I came up with the title. I wrote this phrase, somewhere around the middle of the book – “Life is a brief opportunity for joy.” It was a literary agent, later on, who read the book and spotted it and said, that’s your title Will. It seemed to sum up the entire book. Let’s face it: We are all heading to the same place – oblivion – a hole in the ground. It’s a brief trip and it goes by quickly. Our mission is to be joyous. Life is a gift – it really is.

Many many lawyers make themselves incredibly unhappy. I think sometimes it’s as if they’re determined to make themselves miserable. And depression is, at its heart, a self- punitive behavior. You are doing this to yourself. You are beating yourself up. You are being a bad parent to your inner child, by abandoning him to panic and attack himself for failing to please.

Dan: So when someone struggles with depression as an adult, they’re basically repeating the maladaptive patterns they learned in childhood – – but this time they’re doing it to themselves.

Will: Pretty much. You’re not pleasing others, so you blame yourself for that failure. You place the fault within and dismantle your self-esteem. That’s what I did. Instead of saying to myself maybe I don’t belong here, I kidded myself I did belong there. The truth is, I never belonged in the legal profession. I went because of the money and to try to please my mother in some misguided way. I was a writer and a young therapist, at heart. I would have become a therapist if my parents had done a better job handling my coming out as a gay man. I would have gone into mental health right away because I was fascinated by it. But my parents hated that I was gay and sent me to a psychiatrist to be “cured.” That scared me away from mental health, and in the end, I wanted to make my parents happy and provide them all the money and the status to compensate for being gay. I didn’t even understand what law was. I just went into it blindly thinking well, okay, status and money.

Dan: Now, tell us about the second book and why you wrote it?

Will: Well, the second book has a silly title, Way Worse than Being a Dentist: The Lawyer’s Quest for Meaning. I have a literary agent friend who always seems to come up with my titles and she came up with this one, too. We were kidding over coffee and I said, well basically if you’re not smart enough to get into medical school, you have two choices. You can aim a little lower and go to dental school or you can become a lawyer. Weirdly enough, I’ve had people write me who read the book and said,“You know, I went into dentistry and I am glad I did.” Or, “I went law and damn I should have gone into dentistry.”

So that was the idea – you should have been a dentist. There are people who bash dentists and talk about their high rate of suicide or depression. In actuality, I think that’s a myth. The dentists I know are fascinated by it and doing a lot of good for people. I have a bunch of dentist friends.

But anyway, I came up with this silly title and the book was based on a bunch of columns I wrote for Above the Law, along with additional materials that were either too personal or too honest or too long or too – something – to get included in the originally published columns. Every time I wrote a column, I thought of more I wanted to say and I realized I was starting to exorcise my own demons from that very traumatic experience of trying to be a lawyer years before. I dedicated the book to the partners of Sullivan and Cromwell, just for a laugh. The back photo, if you really look at it, is my firm’s facebook photo from my very first day at Sullivan. They took my photo in a suit and tie – I was terrified, but trying to look confident and successful.

Dan: Give us just a few thoughts or ideas about how lawyers can recover from depression.

Will: First of all: Remember who you are. I had a friend at the firm, years ago, a brilliant guy. He went to Yale Law School and then onto Sullivan and Cromwell. I remember him looking at me one day as if he were saying the most forbidden thing he could ever admit: “Will I just don’t think I’m very good at this.” And I remember thinking, God, that’s how I feel. This guy was so accomplished and I thought, My God, they have really torn him down. He has forgotten who he is. I told him “Look at your record. You were a Yale undergrad and then Yale Law” and on and on; top of his class in everything and I said “How did they do this to you?”

How do you remember who you are? There are a couple of things that can help to snap you out of depressive thinking.

One, remember that you are not always right, but you are not always wrong either. It might not be your fault when things don’t go right at work. Depressed people tend to put the entire fault on themselves. Everything is their fault, they failed and they feel they have no right to anger. I always tell my clients “Look, you have the right to have anger, even if you’re just angry that it’s raining outside. Get angry about something.” It’s about dignity. The inherent dignity of being an adult and possessing a right to your own opinion, a right to your anger.

A child doesn’t really get angry. He gets scared and terrified. But an adult can say, hey, maybe this isn’t the right environment for me. I remember someone at Sullivan & Cromwell, at some point, very sadistically telling me, “Maybe you’re not cut out for this place.” At the time I was desperate. I went to my office and wept because I had to be cut out for it. I had to succeed. Then I realized maybe I am not cut out for this. And I remember laughing and then I thought Oh my God, there is a way out. I don’t have to please. I can please myself. I can remember who I actually am.

I pose this question all the time to my lawyer clients: Who are you really, inside? They say “Well, come to think of it, I was an English major, I loved reading, I loved computer games and I always wanted to go bicycling,” or whatever. It starts to come back and they remember who they are: “You know, I love to bake cupcakes and I love to go hiking. I’m mad about punk music from the 70’s.” Whatever floats their boat – their very individual, quirky, personal boat. And then a person starts to come back to who they really are, to their true self. That’s the beginning of the end of depression – simply remembering who you are, giving yourself the dignity to be you – not trying to care for yourself by pleasing others, but doing it directly – by caring for yourself, in the way you need to be cared for, the way the child inside you – who celebrates life and drinks deep of joy – needs to be cared for. That’s how you beat depression.

The Connection between Depression and Trauma and Neglect

Why do people become depressed? A popular theory is that it is the brain chemistry that is in disarray. But this way of thinking often obscures the issue.

Depression rarely comes out of nowhere. It almost always has an explanation, even if it is not apparent to us. Also, read “What is Your Depression Telling You?”

A better explanation for why many people become depressed is, in my opinion, that we develop vulnerabilities earlier on in our life that predispose us to live a life that is lacking in zest, enjoyment, and meaning.

Oftentimes these earlier vulnerabilities point us to experiences of trauma, neglect, or interpersonal disappointments that may or may not be fully apparent to us.

We almost all undergo some kind of trauma, neglect, or serious interpersonal disappointments at some point in our life, and how we deal with these events can prepare the ground for a later depressive episode. To understand why this is is to understand how humans function.

Responding to Trauma by Losing Ourselves:

When we go through difficult events that we don’t know how to deal with, our psyche responds just like a lizard that loses its tail because it is afraid of a predator. It helps us make an adaptation out of fear, but always at the cost of making us a little less human, or little less ourselves.

Overwhelming shame, for example, might make us abandon a piece of who we are, or in the worst case, our entire person.

How Sexual Abuse Can Lead to Depression:

If I was sexually abused, for example, and didn’t know how to deal with my conflicted emotions and loyalties, it might make me feel bad about wanting and desiring. I might be confused about whether I myself sent out the wrong signals, and might question if the sensation of pleasure I felt, really meant that I desired the abuse, or that my desires are bad.

The psychological compromise I can make to rid myself of my shame is to begin to live a passive life where my awareness of my desires and wants is dimmed, or totally banished. This might mean that I get involved in relationships that are not particularly good for me, that I put up with mistreatment or one-sided relationships because I am reluctant to say “no”, or that I unconsciously seek out bad relationships because I at some level believe I should not get what I really want, or deserve to be punished in some way to atone for my badness.

This compromise I have made to deal with the unbearable experience of sexual abuse has now prepared me for life of lackluster results and lack of enjoyment.

If I become depressed, this is therefore not because there is something wrong with my brain. It is because some part of me doesn’t want the life that I have. My depression is like the last call to me deep from within that indicates that I need to make changes to my life situation because the status quo is antithetical to life. My adaptations to a difficult situation, have now become destructive to what life is really about. Life has turned against life, and my depression is thankfully alerting me to this fact.

Trauma Comes in Many Forms:

Trauma does not have to imply a big dramatic calamitous event, but can refer to any moment when we felt overwhelmed with painful or distressing emotions we did not get the help to deal with. Sexual abuse, physical violence, or growing up with alcoholic parents are some of the more apparent reasons why a person might get exposed to emotional overwhelm, but there are many others.

One of the more frequent causes of adaptations out of fear is the fear of losing love from the people we depend on. In Alice Miller’s book “The Gifted Child”, she describes how this can happen due to growing up with narcissistic parents.

A child, she says, has the need to look into their parent’s eyes and see themselves reflected. If I cry, I need my parent to validate that I am feeling sad, and if I am happy, I need my parents to be happy for me. Unfortunately, some of us look into our parents eyes, and see our parents feelings, not our own. When we are sad, they feel inadequate and get annoyed with us. When we are excited, they are too busy watching TV, and tell us to shush.

These kinds of experiences when they accumulate over time can create serious distortions to our self-image, and can make us abandon ourselves in a pursuit to become more acceptable to our parents.

Research has shown that threats to our sense of safe connection with a caregiver register in our brain as panic, and that losing our connection completely registers as pain. To avoid feeling these unbearable emotions, we will do a lot, even if it means ridding ourselves of our natural spontaneous desires and feelings.

Other ways to deal with the threat of loss is to become numb, or to become what the psychiatrist Karl Jaspers has described as a “dead person with wakeful eyes”.

What Does Depression Have to Do with It?

When we pay too big of a price to stay safe early on in life, we enter into adulthood ill prepared to deal with life’s challenges.

If we have gotten used to numbing ourselves to unpleasant emotions, we will likely also find it difficult to feel joy and excitement.

If we have learned to live our life in an effort to please our parents, our accomplishments won’t really mean much to us, and we will pursue goals that are not aligned with what we really want.

If we had to abandon ourselves because of shame about our needs or our feelings, we will forever have a sense of emptiness inside because we aren’t fully honoring and accepting who we are.

In many cases, when we really look at the reasons why people become depressed, we find a childhood history of trauma, abandonment, or neglect that has resulted in adaptations that are currently getting in the way of living a meaningful life.

Depression is often simply telling us that we are not really living our lives as ourselves.

To resolve this situation is to confront the underlying reasons why we make the choices we do, and to see to what extent we are really living a life based on avoiding shame, anxiety, guilt, and pain, and not a life based on our genuine feelings, needs, and aspirations.

Rune Moelbak, Ph.D., is a psychologist and depression specialist in Houston, Texas. He is the owner of Better Therapy, a therapy practice for people who want to discover the underlying roots of their current psychological problems.

Chronic or Recurrent Depression: Why Does Depression Go Away and Then Return?

Some people who experience a single depressive episode will fully recover, never to experience another. (Sign us up for that, right?)

For about 40-60% of us, however, depression is a chronic illness that will come back. By the time most people get treatment, they have experienced multiple depressive episodes already.

Good news: with treatment, recurrences can be less severe, occur less frequently and not last as long.

So why does depression seem to rear its ugly head over and over again for most of us?

Saying you have depression is like saying you have a terrible headache, in that you have disabling symptoms, but it says nothing about the cause of those symptoms.

For instance, in the case of a headache, you may have a migraine, a tension headache, a stroke, a brain tumor, a concussion, or something else. The underlying cause informs the prognosis and treatment of your headache, whether it will come back and the best course of treatment.

With depression, we are just beginning to understand the underlying causes and contributors – which could be medical, neurological, psychological or social – many of which are ongoing and lead to a propensity for depressive episodes.

Depression has a genetic basis, but whether that’s because of biological differences in brain chemistry or temperament or something else, we don’t know yet.

We do know that people in stressful situations or lifestyles have more depressive episodes. This could be stress brought on by work, it could be relationship-related, a traumatic or neglectful childhood, or an unsafe living or work environment.

Recurrence can be caused by psychological makeup – much of which can be based in how we view ourselves, others and everyone’s place in the world. Studies have shown that psychotherapy can change this brain makeup to positively influence our outlook.

There’s still so much to learn about the disease. We need to recognize that for many, it’s a biopsychosocialspiritual illness with multiple contributing components that must all be addressed to create the highest likelihood for treatment to work.

Psychotherapy remains the most effective treatment for depression, and should be part of every patient’s plan for recovery.

Someone with chronic, disabling depression may also benefit from a comprehensive evaluation at a center that respects all contributors to the illness to treat the whole person in an individualized, comprehensive way. One place to do this is at The Retreat at Sheppard Pratt, which also specializes in treatment-resistant depression.

Depression is an intensely personal experience. When pursuing treatment, be sure that you are being understood, and obtaining the level of support you need. For some, particularly those working in a highly stressful environment, that could mean getting away for a short time to focus on recovery, even though it can be a tough decision to make. Be open to all levels of care.

It can be disheartening to realize that your depression will likely come back. Know that you’re not alone, as about 6.7% of the U.S. population have had at least one depressive episode in the past year.

Keep working on your recovery, talking about it to reduce stigma, and supporting those who are studying mental illness. One day, we will know more.

By Thomas Franklin, M.D., Medical Director, The Retreat at Sheppard Pratt

Dr. Thomas Franklin is the medical director of The Retreat at Sheppard Pratt. He is a clinical assistant professor of psychiatry at the University of Maryland School of Medicine and a candidate at the Washington Center for Psychoanalysis. He is Board Certified in Addiction Medicine and Psychiatry and has extensive experience in psychotherapy, psychopharmacology, and addictions and co-occurring disorders. Dr. Franklin previously served as medical director of Ruxton House, The Retreat’s transitional living program, before assuming the role of medical director of The Retreat in 2014.

Working Through Stress and Depression

Depression is tough. Stress is also tough. Being depressed and stressed at the same time is even tougher. As a person who struggles with depression and has to manage stress on a daily basis, I have some good news for you:

Managing stress while being depressed is possible if you have a plan.

Depression has been a part of my life from as early as I can remember. Like a never-ending fog, I walk through it each day. As I have gotten older, I have discovered that it manifests itself in a variety of ways.

● Sometimes it feels like anger.
● Sometimes it feels like sadness.
● Sometimes it feels like emptiness.
● Sometimes it causes me physical pain.
● Sometimes it is a combination of the above.
● Sometimes it is all of the above.

Like most children, I wasn’t as aware of my thoughts and feelings as I am now, as an adult. At it’s worst my depression became extremely frustrating and overwhelming. The only way I knew how to cope with it was to act out.

Acting out included violent outbursts and harming myself.

● Acting out got me hospitalized 3 times in a psychiatric hospital.
● Acting out got me expelled from 3 schools.
● Acting out lead me to try and take my own life at age 10.
● Acting out mad friendships and dating difficult.

Nowadays, I still experience depression. Fortunately, I don’t act out like I did as a child. Through therapy, support groups, and being a mental health speaker, I have learned that there are other people who struggle with depression, too.

In addition to depression, I also get stressed out from time to time. Stress can be the result of challenges at work, at home, or in my personal life. Sometimes stress is the result of living your life. Let’s face it, life can sometimes just be overwhelming.

Through learning to manage my depression, I’ve also learned to better manage my stress. I’ve learned the hard way that being stressed while you are depressed is a crisis waiting to happen. If you don’t have a plan in place to manage both, it can end up costing you your job, your health, your relationships, and worst of all, your life.

Here are some tips that I have learned to help me cope. They are part of my plan to manage my depression and stress:

1. Get sun every day

According to Healthline, “Exposure to sunlight is thought to increase the brain’s release of a hormone called serotonin. This is associated with boosting mood and helping a person feel calm and focused.”

My goal is to shoot for a half an hour of sun. Ironically, an hour before I began writing this article. I was feeling extremely stressed and sad. I spent about a half an hour in the sun and am feeling much better.

2. Exercise every day

Like sun, it’s important that I keep my body moving, even if it’s just a quick ten-minute walk in the morning. In fact, you can walk and get sun at the same time. The combination of both, even for a short period of time will do wonders for your stress level and depression.

My trainer and nutritionist, Maik Weidenbach, has helped me manage both my stress level and depression with customized plans. Check out his article, Depression and Exercise: 10 Tips to Stay Motivated and Strong and his book 101 Fitness Myths.

3. Writing Things Down

When you are feeling overwhelmed, sad, angry, upset, anxious, etc…, a yellow legal pad can be your best friend. By taking a few minutes to write down everything that is on your mind you can quickly clear your head. As you clear your head, you will feel better.

Also, by seeing what is on your mind written down on paper, you will feel less overwhelmed. I am not sure exactly why this works, but it does. Ironically it’s an exercise that many therapists and professional organizers give their clients.

As I am finishing up writing this article, I feel a bit depressed and a bit stressed. Regardless, it’s not stopping me from being productive because I have a plan in place that I used to take care of myself today.

Managing your stress while being depressed is doable, but you have to be proactive. I encourage you to make a commitment to try one of the ideas listed above every day for the next week. I also encourage you to spend the next week creating a plan for yourself to manage your stress.

What will you include in your plan to manage stress while depressed?

Mike is a mental health advocate and creator of the website Transforming Stigma. To read more about Mike and his courageous work, click here.

Copyright, Daniel T. Lukasik, 2016

What I’ve Learned About Depression: A Lawyer’s Journey

About a year ago Dan invited me to submit a guest article for his website. I felt honored and immediately accepted. The invitation coincided with the twentieth anniversary of my depression diagnosis, and I’d been reflecting on my experience with depression over the past two decades. It seemed like the ideal opportunity for me to offer others the benefit of my hard-earned wisdom and experience.

But that didn’t happen, at least not the way I originally intended. When I sat down to write, the words didn’t flow. As a former teacher who’s taught communication courses at three major universities, and as a practicing attorney who prides himself on his ability to write quickly and well, this experience was unusual and disconcerting. When my students would tell me they were having trouble writing a paper or preparing a speech, I told them it was most likely because they didn’t understand the subject matter well enough. I came to realize that was a big part of my difficulty too. That and being guilty of not practicing what I wanted to preach.

I remember clearly the day I first went to see a psychiatrist. For several months I’d felt overwhelmed at work. As an associate in a successful litigation-oriented law firm, I considered myself fortunate to have the opportunity to work on a number of complex, high-exposure cases. I appreciated the confidence the partners had in my ability, and I wanted to prove I was worthy of their trust. I also wanted to demonstrate to my clients that I was more than capable of assuming primary responsibility for their cases and obtaining the best possible results for them.

At the same time, my marriage was deteriorating. My spouse and I met and married in graduate school. When I grew dissatisfied with my work in academia, she suggested law school. I’m from a family of lawyers, and we both saw this as a good career option for me and a positive move for our relationship. But while the law school years were mostly happy ones, things changed when

I entered private practice. The hours were long and my schedule was less predictable that what we’d become accustomed to. We spent less time together and our relationship became even more strained. Work and home life grew increasingly stressful, and I reached the point where I knew self-help was not enough. That’s when I called a psychiatrist I’d worked with on a few cases and had gotten to know fairly well.

Looking back, my story must have sounded familiar and rather mundane to the psychiatrist – an ambitious young lawyer working hard to establish himself and provide for his family who felt he could handle an ever-increasing level of stress, until he couldn’t. We talked for about twenty minutes that day before he walked over to a cabinet in his office, opened the door and tossed me a sample box of medication. He told me I was suffering from depression, and that I should take the antidepressant he gave me and come back in a week.

I felt oddly elated when I left the psychiatrist’s office. I had not only a clear diagnosis but a simple way to treat my depression – take a pill! I took my first dose that day after lunch. At the time I thought the medication would solve most, if not all, of my problems. It did help, but not as much as I’d hoped. And there were side effects. I tried other antidepressants and found optimizing the benefit-to-side-effects ratio was tricky. Starting, stopping and changing medications was frustrating for me and for my spouse, who was not depressed and didn’t seem to understand or sympathize with my struggle.

During this time I read a lot about depression, and fortunately one of the books I found early on was Dr. Richard O’Connor’s Undoing Depression. To me, it is still the best single book written about depression for a lay audience. Dr. O’Connor’s academic training, his years of working with clients and his own personal experience with depression have given him a depth of knowledge and understanding that rings true to those of us who seek to identify and replace our “skills of depression” with healthier and more adaptive alternatives. It’s the first book on depression I recommend to friends and colleagues, and it’s one I find myself returning to from time to time for inspiration and guidance.

I would like to tell you that as the result of therapy, medication and self-help I beat depression and have lived happily ever after. But anyone who’s struggled with the “Black Dog” knows that’s not how things usually go with depression. As Dr. O’Connor noted in a recent article for this website, “[t]he ugly fact is that depression is very likely to reoccur. If you had one episode of major depression, chances are 50:50 that you’ll have another; if you have three episodes, it’s 10:1 you’ll have more.”

No one suffering from depression wants to hear those statistics. We all want an easy solution, whether it comes in the form of a pill, or a few sessions with a therapist, or just enduring the depression until it simply goes away on its own. And for some that approach works. I know one professional colleague who years ago had a single episode of major depression precipitated by marital discord and divorce. He sought professional help and took medication for a period of time until he regained his emotional equilibrium. To the best of my knowledge, he has remained depression-free ever since. But in my experience, and in the experience of many people I’ve spoken with over the years, my colleague is unfortunately atypical.

We’ve known for a long time that lawyers suffer from depression at a far greater rate than the population as a whole. A recent CNN article reiterated the now-familiar finding that lawyers are 3.6 times more likely to suffer from depression than non-lawyers. The same article reported data from the Centers for Disease Control and Prevention indicating that lawyers have the fourth highest rate of suicide among professions, trailing only dentists, pharmacists and physicians.

In an adversarial profession where there are “character and fitness” requirements for licensing and acknowledging depression may be seen as a career-threatening sign of weakness, barriers to treatment and recovery can seem insurmountable.

While the reasons lawyers are particularly vulnerable to depression are varied and not fully understood, it is clear that from a mental health perspective law is a high-risk profession. It is also becoming clearer that the risk of becoming clinically depressed increases the day a student starts law school. A study by Dr. Andy Benjamin of the University of Washington estimated that thirty two percent of law students suffered from depression during their first year in school. That figure rose to forty percent by the time the students graduated. For this reason early education for law students about this “peril of the path” is essential. In his post titled “In the Beginning: Depression in Law School,” Dan shares this excerpt from correspondence he received from Dr. Benjamin:

“Since the publication of our research about law student and lawyer depression, depression still runs rife for law students and practicing attorneys – nearly a third of all law students and lawyers suffer from depression. The data to support this statement have been published since the early eighties when the studies were first conducted. Several subsequent empirical studies have corroborated the grim findings up until 2010. As the stress, competition, and adversarial nature of the profession have continued to take their toll, not surprisingly, the rates of depression have not changed. Law students and lawyers remain at the greatest risk for succumbing to depression, more so for any other profession. After nearly forty years of compelling evidence about the prevalence of the severity of depression for the legal profession of law, more meaningful systematic changes must be implemented throughout the professional acculturation process of law students and lawyers.”

Few of us, if any, who practice law and who’ve been directly or indirectly affected by depression would take issue with Dr. Benjamin’s conclusion. We’ve made progress in terms of improved awareness, education and professional attitudes toward depression, thanks in large part to lawyers like Dan Lukasik and clinicians like Richard O’Connor who’ve had the courage to share their own experiences with depression. But the legal community has a long way to go, and for the most part depressed lawyers must fend for themselves with little or no support from their professional peers.

So, returning to my theme, what have I learned in the past twenty plus years about living and practicing law with depression? Many things, but perhaps the most important is that depression is persistent and change is hard. As Dr. O’Connor has explained so well, we get good at “doing depression” and our patterns of depressive behavior tend to be self-perpetuating. “Depression is highly treatable,” he wrote in a recent guest blog, “but if you want a lasting recovery you have to change your life.” And how do we effect meaningful, lasting change in our lives? According to Dr. James Hollis – author, therapist and student of Carl Jung – we need to cultivate the skills of insight, courage and endurance.

“To develop insight we must begin to see the causes of our depression and the ways in which we perpetuate it through our patterns of thinking, behaving and relating to others. Therapy, self-help literature and self-reflection may all play a role in this process. And while insight is essential to effecting positive change, it is not sufficient. We must act on our insight, and to do that we need both the courage to step out of our comfortable but dysfunctional patterns and the endurance to stay our course once we find it.”

One of the most valuable insights one can have about depression is that insight isn’t enough. I used to think it was. When I was diagnosed with depression and began to learn about it, I tacitly assumed that as I gained insight into my condition my life would quickly and magically change for the better. It didn’t. I’ve learned that many other people have made the same assumption without being aware of it. It would be wonderful if having insight into our depression turned off the symptoms the way flipping a switch turns off an electric light. But experience teaches us that our depression switches will flip back on unless we take appropriate and persistent action.

No sensible person would choose to have depression. I didn’t. But since we are not given any real choice in the matter we must learn to accept and live with it in the best ways we can manage. I like to think I’m a stronger, more resilient, and perhaps even “better” person because of my experiences with depression. It hasn’t always been easy, or fun, but there is satisfaction to be found in accepting the ongoing challenge and continuing to rise to it.

Perhaps Rainer Maria Rilke offered the best and most succinct advice when he wrote:

Let everything happen to you

Beauty and terror 

Just keep going 

No feeling is final.

By William B. Putman, Esq.

Bill is a 1991 graduate, with honors, from the University of Arkansas School of Law and a partner at Taylor Law Partners in Fayetteville, Arkansas.

From Breaststroke to Black Float: Dealing with Depression

One description of depression is that it is like the shapeless sagging of a rubber band that has been kept tight and taunt for too long. When feelings have been strong, stressed, unprocessed, or held captive over a period of time, we just stop feeling altogether. Persons and events no longer have the power to enliven us; we operate on a low level cruise control. Usually we keep functioning, but there is no positive or creative affect toward persons and things, and even less toward ourselves. We basically stop living our only life.

Many lawyers operate at this level, without even knowing that it is a kind of death. They have learned to take it as normative and unchangeable. Life is no longer enjoyable, and almost everything becomes another excuse to be upset, angry, aggressive, afraid or defensive. We all know many people who live at this level.

But I would also like to describe another common source of depression that is less often addressed: basic meaninglessness. Religion, philosophy, and culture are supposed to address that foundational need. But when religion or spirituality is largely in the head, mostly fear based, or merely moralistic, there is a huge vacuum in most people. The soul and the spirit are not fed at this level. I am afraid that it is the most common form of religion we now have in the West. Such people, often very smart, have no beginning, middle or end to their life story, unless they totally create it for themselves like some kind of Nietzschean “ubermensch”. This is inherently too big a task for one autonomous individual.

The “Is that all there is?” feeling overcomes most people in our culture somewhere in their mid to late forties, if they are at all typical. If you are riding a fast track of upward mobility, external success, and lots of control, you might be able to put it off for another decade. But it is hardly worth it, because then the patterns of avoidance, depression, splitting off, a basic non-intimacy with one’s deepest life, are so entrenched, that it is very hard to emotionally and intellectually change without a lot of grace – – and a lot of “grit your teeth” and try to bear it. We are largely unteachable at that point.

The grace, of course, will always be available, but often we have lost the recognition of it, the desire for it, the trust in it, and the ability to cooperate with it. We do not even know there is such a thing as grace (Acts 19:3), and it is indeed an “it” instead of a Presence, a power and a possibility. In fact, for an ego that has been in overdrive for forty years, the reception of grace will actually feel like a defeat, a humiliation, and a failure. If “I” have been doing it all along, any “we” experience of union and cooperation with Another will actually feel like a loss of control and a loss of self-importance. It will be like switching from an eager breast stroke to a back float, and still having to assume that I can still get there. That would be hard for any successful lawyer, and actually for any of us.

At this point, one’s overdeveloped faculties (rational mind, willpower and Yankee can do!) will have to give way to those that were left underdeveloped for the sake of what we call in men’s work “building our tower”. What do I mean by those “underdeveloped faculties”? Well, first of all, I should state that they are not just underdeveloped; they are actively rejected and denied as values at all. I think that is why religion tended to speak at this process as “conversion”. Because if it is authentic, it is a rather complete reversal (“convertere” in Latin) of previously held virtues and values. Probably also why authentic religious conversion is rather rare.

Okay, here goes. This is what changes. Things like admitted powerlessness begin to be admired over claims to power, unknowing over knowing, living without resolution over demanding closure, giving instead of taking, waiting instead of performing, listening instead of talking, letting go instead of collecting and hoarding, empathy with instead of domination over. The more traditional words that were used for these values were three: “Faith”, “hope”, and “charity”. What St. Paul says, “are the only things that last” (1 Corinthians 13:13). I am sure he is right. But, mind you, these are virtues that are only learned by many trials and many errors by the second half of life, at best. In the first half, they actually do not make sense. The trouble is that many lawyers in our secular world are not moving to the second half of life. They are becoming elderly but they are not elders.

We all know that one part of each of these equations had to be developed to be lawyers at all. You would not have built any kind of tower unless you were powerful in some sense, had your facts, moved towards closure, and were normally much better at talking than listening. You lived in one way, but you died in another. Eventually that unintended death catches up with you. There is a huge hole in the soul of manglers and it gnaws and longs to be filled. It is another form of depression, but potentially a life changing one. Please trust me when I say that this hole has immense energy and possibility hidden within it. Maybe it is even the necessary vacuum to hold a new Infilling.

At first you will not know where to turn, especially if you have a good mind, and you are used to explaining everything and determining your own direction. You have no practice at this different set of virtues. To be honest, only God can lead at this point. You had best give up, because all of your previous tools are useless and even counter- productive. This is exactly why Bill Wilson made the first necessary step of Alcoholics Anonymous the absolute admission of “powerlessness”. This is about as counter intuitive as you can get, or even seemingly non-rational (not irrational!).

So what am I proposing that you do? Really, not that much. I am first of all trusting in your ability to hear some of what I just tried to say. If you have persisted in reading this far, you are hearing me at some non-resistant level. We call this the “contemplative mind”, where you turn off the need to be right or wrong, agree or disagree, and just let something work on you at whatever level of truth there is. (Everything Belongs, Crossroad Press, 1999). The Eastern religions would call it non-dual thinking.

Secondly, I would encourage you not to try too hard, no self-assertion because that will only deepen your addiction to your own way of doing life. You will try to “convert” yourself by yourself, which is actually a oxymoron. If you try to be heroic and superior, you will only get more of the same, but now disguised with a religious or moral sugarcoating. Please trust me on this one, all great spirituality is about letting go. YOU cannot do it. IT is done unto you.” (Luke 1:38 and 28:43). You are always the allowing. Someone else is winning at this point, and you are getting your first lesson in creative losing.

Thirdly, I would like you to forgive yourself for your life’s mistakes. God never leads by guilt or by shaming people. Take that as an absolute. God always leads the soul by loving it at ever deeper levels, and if you want to be led, you absolutely must allow such unearned love. Like all grace, it will feel like losing, not gaining, surrendering not taking, trusting not achieving, allowing instead of “making the case.” Like all authentic conversion it will feel like dying (See John 12:24 or Old Adams’ Return, Crossroad, 2005), but it will really be living. Fully, for the first time. God does not love you if you change; God loves you so that you can change. God is not the rewarder and the punisher. God is the energy itself; more of a verb than a noun, according to the great mystics.

This is one case you are not going to be able to win. In fact, I am convinced that the Gospel of Jesus really is the hope of the world precisely because it totally levels the human playing field. Now we win by losing, and if we are honest, we all have lost, failed, and been untrue at some levels (Romans 5:12). That humiliating recognition is the hole in the soul that allows God to get in – – and ourselves to get out – – of ourselves. Don’t miss such an entrance or exit. It is the Big One.

Fr. Richard Rohr is a Franciscan priest in New Mexico Province and author of several books including Hope Against Darkness and From Wild Men to Wise Men: Reflections on Male Spirituality. He is the founder of the Center for Action and Contemplation in Albuquerque, New Mexico.

Undoing Depression in Lawyers

There’s some interesting research to suggest that happy people view the world through certain comforting illusions, while depressed people see things more realistically. [i] For instance, the illusion of control. You can take a random sample of people and sit them in front of a video monitor with a joy stick, and tell them their joy stick is controlling the action of the game on the screen. (But the point of experiment is that it actually doesn’t). Depressed people will soon turn to the lab assistant and complain that their joy stick isn’t hooked up correctly. Normal people, on the other hand, will go on happily playing the game for quite some time.

I think this explains a lot about why lawyers are so prone to depression. Because of their experience with the law, most attorneys have lost their rose-colored glasses some time ago. (Or else they never had them and chose the law as a career because it suited their personality). Attorneys know that life is hard, and doesn’t play fair. They’re trained to look for every conceivable thing that could go wrong in any scenario, and they rarely are able to leave that attitude at the office. They see the worst in people (sometimes they see the best, but that’s rare). They tend to be strivers and individualists, not wanting to rely on others for support. They have high expectations of success, but they often find that when they’ve attained success, they have no one to play with, and have forgotten how to enjoy themselves anyway.

All this makes it hard for attorneys to get help with their depression. They tend not to recognize it as such; they just think it’s stress, or burn out, or life. They don’t expect that anyone is going to be able to help. Most of my attorney-patients have contacted me because their relationships are falling apart, but they don’t see that it’s depression that makes them such a lousy partner – tense, irritable, critical, joyless, tired all of the time, relying on alcohol or other drugs. If they’d gotten help for the depression a couple of years previously, their spouse wouldn’t be moving out now. The truth about depression is that it not only makes you feel horrible, it wrecks your life. And that’s why I wrote the book, Undoing Depression, in the first place. I was running an outpatient clinic, and grew exasperated with seeing the people whose lives wouldn’t have been so ruined if they had got some help when they first needed it – before they alienated their children and spouse, got fired, went into debt, developed a substance abuse problem, etc. I thought there was a need for an intelligent self-help book, one that points out all the bad habits that depression engenders and which, in a vicious circle, keeps reenforcing the disease. But the truth is that self-help isn’t nearly enough for most depression sufferers. It’s as if you stepped over an invisible cliff, and you can’t find your way back doing what you normally do, because that’s what led you over the cliff in the first place. Depression is the original mind/body disease; your physical brain is damaged because of the stress in your mind, and you’re unlikely to undo that damage without help.

Depression is highly treatable, but if you want a lasting recovery you have to change your life. The ugly fact is that depression is very likely to reoccur. If you had one episode of major depression, chances are 50:50 that you’ll have another; if you have three episodes, it’s 10:1 you’ll have more. But you can improve those odds if you get good professional help, with medication and with talk therapy. We won’t put your rose-colored glasses back on, but we can help you see how negative thinking and the negative acting is contributing to your disease.

[i] See for example, Shelly Taylor: Positive Illusions; and Julie Noren: The Positive Power of Negative Thinking.

Richard O’Connor, Ph.D., is the author of two noteworthy books, Undoing Perpetual Stress: The Missing Connection Between Depression, Anxiety, and 21st Century Illness andUndoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You. He is a practicing psychotherapist with offices in New York City and Canaan, Connecticut. He has suffered from clinical depression and is a member of a depression support group.

Depression is a Thief: It Steals the Stuff You Love

Depression is a thief. It sneaks into your heart and steals from you your passion: not only your power to conjure enthusiasm but also those exact things that once, that maybe all your life, excited you.

In other words, those things you loved not in the sparkly-pink-hearts sense of kissing or strolling along the beach with them or wearing white lace gowns to marry them — although in some cases, those too: Depression whooshes in through open windows, easily as any breeze, then yoink!

Burglary victims, stickup victims: Unlike us, they realize they’ve been robbed.

All my life, until last year, I was very interested in very many things. The vastness of these interests made my childhood bedroom a museum, piled with barometers, feathers, halfpennies and fossils. So numerous were my passions that picking one as a college major or career felt like infidelity: Becoming a Wild West historian meant not becoming a marine biologist. Mastering Japanese meant not mastering Danish (weird, I know) or breeding dragonflies. Designing hats meant not being a forest ranger or parapsychologist or ethnomusicologist or bonsai gardener or gemologist. Instead of choosing one, I chose to write about them all, and more, and so went 30 years.

Then whoosh. After a lifetime spent looking things up, looking at things, spinning rapturous anecdotes about gold prospectors and sunken ships, last year these topics that had so thrilled me that I mistook them for myself lost all their light. They existed: France did not roll up like a rug and vanish. Sea chanteys were not erased from history. But suddenly I saw these things I’d loved the same way I’d always seen math and sports: as flat, alien realms irrelevant to me.

On shelves, polished agates and haiku volumes mocked me. In the world, all sumptuosity vanished from surfboards and cinnamon rolls. My keyboard rapidly became an enemy. Writing — shimmering reefs of detail, one deft word — was also yanked away, leaving me blinking blankly at my hands which long wrought fun and wonder and a living but now produced less and less, plus every word they typed felt like a lie. Which is to say: a sin.

Discussing boredom bores, as every poet knows. So — those who’ve never been there, I will spare you. Those who have, and are: Accept my fellowship. Get help. Last year I noticed certain friends avoiding me because, sans hilarious narwhal factoids and bone-marrow narratives, I was puzzlingly dull.

But I feel somewhat better now, so I can warn: Depression is a thief. It steals intangible yet priceless things. We have every right to shout I want my stuff back.

Stolen jewels you might replace. Stolen cash you can report to the cops. Stolen cars sometimes track their stealers via GPS. Passions, though. “Excuse me, officer, I’ve lost my enthusiasm, yearning, creativity and curiosity. I’ve lost interest in archery and baking. Oh, and also in bringing my kids to beaches. A marauder took it. Catch that thief! Issue an all-points bulletin!”

To whom do you report stolen interest in Tanzanian politics, preference for oolong over keemun, preoccupation with stars if you’re an astronomer?

Report them to your therapist, if you have one. But if you don’t? Because you haven’t yet assessed your losses? Because you think they’re your fault?

To whom, then? Partners? Friends? See, that’s the thing. These passions we’ve lost were what bonded us to them. Worse, if our friends and partners are themselves those passions — well.

Depression is a cruel thief that raids your heart, your home, your future, your present, your past. It steals your most precious possessions not to keep or use or give away or sell but just because they’re there. Those loves for which you lived become loot burning by the wayside. This is stealthy, silent theft that masquerades as aging, failure, sulkiness, stupidity, ingratitude, unmindfulness, unwillingness to try. This is a monumental crime that masquerades as just another day.

Depression is a master thief that slips through gaps you never knew you had. As deft in daytime as in darkness, it wakes no watchdogs and it trips no alarms. It happens to the best of us.

Which is not to say I’m the best. It is a mere figure of speech. But we are legion, those of us who have been robbed in this manner stand here stolen-from, raising no chorus of outrage because most of us don’t know we’ve been robbed. We sensed neither warning nor denouement, no “OMFG” moment but a slow and subtle awareness: Huh. Where’s my awe?

Another tricky aspect of depresssion’s thefts is that it leaves the shells of what it takes. And/or replaces stolen goods with holograms.

So we say: See? Nothing has changed. So celebrate! Seize every moment and rejoice! You’ve got nothing to cry about. No leprosy, no blindness.

So for a while we sip coffee calmly in our homes which still seem full. See, there’s my laptop. There’s my child.

We tell ourselves we cannot have been robbed because our lives look as they did before — which, to the naked eye, was perfect.

All the while, depression runs in circles, laughing, long arms loaded with our stuff. Once — if — we realize we’ve been robbed, we scoff because our losses are all in our minds.

Which makes us say, in hopeful moments: This was not grand theft but a transition. Transformation. What was lost will be replaced with other, better things — as in tales whose frogs become princes and straw becomes gold. So maybe, hey: Instead of Danish, Cornish. Or no languages at all but … what? Chemistry? Shoes? My reluctance to write: Is this too not catastrophe but a cosmic shift, a breathless pause before I start to sing or sail instead?

Or will I write again, but about wildly different subjects, such as sports, or in some wildly different manner, such as rhyme?

By turns pompous and panicky, I pronounce my own anomie a holy threshold, a garlanded crossroads beyond which — behold.

Or not.

Yet.

I feel somewhat better now than last year, whose sleepless nights sent me crawling across carpets, tearing into bits not one but two paperback copies of The Secret Sharer, sobbing How can this be my life now? when that life looked like paradise and I thought: I will be punished for sorrow I cannot explain or justify. I’ll be given “something to cry about” for failure to snap out of this, failure to meditate, failure to write, failure to sleep. For not demanding and getting my stuff back, abracadabra, I will be penalized with injury or irony. On some bright day I shall be sickened. Stabbed. Because in 2014 I lost interest in 10,000 things.

But really, I feel somewhat better now. This geode glitters in the sun. I saw pelicans yesterday. My reluctance to write, my sense of having nothing to say anymore to anyone, scares me — and makes me, among other things, a stranger to myself.

Pssst: Depression doesn’t just steal. It also lies. In voices very like our own, which we mistake for ours, it asks: Why did you ever have such pointless passions anyway? They weren’t passions but pastimes, tools for killing time.

Depression says: You idiot. You brat. Depression says: I did not sneak into your heart and home and steal your loves: You lost them, scatterbrain. You let me in.

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